Tuesday, September 8, 2009

When your therapist makes a mistake

Sometimes your therapist will make a mistake:
- an insensitive or clumsy comment
- an intrusive line of questioning
- a failure to notice, attend to, or take seriously, something important in the session
- unwelcome or way-off-base advice.

If such problems are recurrent and severe, it may be a sign that you don't have a very good therapist, and that it is important to seek a referral to someone else.

Some problems could be forms of malpractice (e.g. being given dangerous medications inappropriately), and could be pursued through legal channels.

I think that a healthy therapy frame is one in which the therapist will be open to discussing any problems or mistakes.

The therapist should sincerely apologize for all mistakes, and be open to making a plan to prevent similar mistakes from happening again.

You deserve to feel safe, respected and cared for in therapy.

There are other types of conflicts that can arise in therapy, when one person or the other feels hurt, frustrated, or misunderstood. I can think of situations over the past ten years in which there have been tense conflicts, and in which my patient chose not to continue seeing me. In some of these cases, I have felt that there was a conflict--a problem in the relationship--which needed to be resolved. Sometimes these conflicts were made more likely by my own character style or behavioral quirks; other times I think these conflicts were at least partly "transferential," in that my actions triggered memories associated with conflicts from previous relationships (such as with parents growing up). In a few cases, I think the conflict was influenced by active mood symptoms (e.g. severe irritability). I think many conflicts have a mixture of different causes, and are not necessarily caused by just one thing.

In any case, I do strongly believe that resolving conflict in therapy is very important. And I believe a therapist must gently and empathically invite a dialog about conflicts, in a manner which is open, non-defensive, and "non-pushy." Such a moment of conflict-resolution, if it occurs, could be one of the most valuable parts of a therapy experience, a source of peace and freedom.


Rach said...

Garth, Great post as usual.

Perhaps you could suggest ways of initiating such a conversation with one's therapist.

GK said...

It takes courage to bring up problems.

I think it is good when a therapist can periodically ask about concerns, conflicts, or problems in the therapy. This can be an invitation to initiate the conversation, and make the process easier.

Also, I think it is a good practice for a therapist to encourage discussion about problems in the therapy, as part of an introduction to the therapy itself, during the first session.

Hopefully your therapist is open to the idea of discussing conflict which occurs in the sessions. A way to test the waters might be to ask your therapist if it is okay with him or her for you to bring up concerns or problems that happen in the therapy sessions.

It can be a relief to know that you can bring up any sort of problem, large or small, and know that you will not be rejected, dismissed, or subject to an angry response.

Anonymous said...

I have myself at times felt that a comment made by a therapist was insensitive or have wondered why s/he did not suggest medication sooner (couldn't they see how much pain I was in) and just the opposite sentiment when offered medicine (why offer this medication or why so soon?)

Yet I'm usually able to to reconsider my sentiments, when less anxious and irritable, and realize that it's my fear talking and it's my frustration with my anxiety/mood problems.

I personally find that 2-3 sessions gives me sufficient time to decide how much I'm willing to trust a therapist. I am an intuitive person but my anxiety precludes a good "read" so after several sessions I have developed a fairly accurate view of the person specially given that I have a background in psychology myself.

After that I try to analyze a conflict or perceived insensitivity in several ways:

1. it could be intentional. I have a certain personality and the therapist may refuse to complement my personality and he may be attempting to disrupt the dynamics at work, ones that may have been present in previous dysfunctional relationships I've had.

2. it could be a mistake on behalf of the therapist and I try to gather courage and bring it up usually prefacing it by all the positives of our relationship. I feel that nobody likes to be criticized and that includes therapists.

3. I also consider transference. If he says "oh, why you always so serious" or tries to laugh away an issue I bring up, I may be reminded, say, of a difficult relationship I have with my father who doesn't take things seriously. So I'll note my strong emotional reaction to the therapist and try to think about it at home. Did the situation call for such strong emotional reaction? To get tearful over that?

There are times that it is quite obvious that a therapist is not competent and should not be practicing. My one and only experience with a verbally abusive and rude therapist that asked me to leave the first session was traumatizing (and I should have left earlier myself) but taught me one very important lesson:

If you feel belittled and humiliated by a therapist, there is no rationalization whatsoever for that. One must believe in the humanistic view that we are all basically good no matter what we have done in the past or how we feel. If a therapist is unable to sympathize with the needs, fears, and hurt that is beyond one's dysfunctional behavior, one is unable to grow and realize one's potential.

This is what I try to do in my life as well, to imagine the person who has angered me as a child, to sympathize with that vulnerability and humanity, to be able to see the many ways we are the same...and that difference somehow becomes less important. It's hard but with practice it gets easier.

Thanks again for your great entry.